Provider Demographics
NPI:1891796983
Name:DEWEESE, ERIC L (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:DEWEESE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:STE 1370
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-837-5571
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:112 HOSPITAL LANE
Practice Address - Street 2:SUITE 303
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1998
Practice Address - Country:US
Practice Address - Phone:317-718-4000
Practice Address - Fax:317-718-4005
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01028571A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100258100Medicaid
INP00845895OtherRAILROAD MEDICARE
INP00845895OtherRAILROAD MEDICARE
IN267030YYYMedicare PIN
IN100258100Medicaid
IN290013264Medicare PIN